Project #69308 - Case study 3

In the day clinic at mercy Hospital the following case was seen: Mrs. C brought her twin children Richie and Joanie in for a consult because both of the twins have been experiencing problems. The twins are 17 years old and have been in fairly good health. Mrs. C’s pregnancy was unremarkable other than the fact that she went through a period of extreme stress when her husband lost his job and she took on an additional job during months 3-6 of gestation. She also suffered from a severe episode of the flu at that time. The twins were born that January. Richie had been complaining about headaches in the right side of his head, mostly clustered around the frontal portion of his brain. Whenever he experiences these headaches his mother notes that he becomes “unglued” and his personality changes. After the headache subsides he enters a state of exhaustion and shows little or no affect for days. His friend Ralph M has also commented that that during classes at high school that Richie will suddenly show outbursts of inappropriate emotions. When the class shows horror at his behavior, he does not understand what their problem is. What prompted the trip to the clinic was that Richie was found in a broom closet because he was terrified of his locker. He had been under a lot of stress recently because he was working on a science project where he had to breed mice, but his female mice were not becoming pregnant. Since Mrs. C was bringing in Richie she thought she’d make an appointment for Joanie as well. At the age of 17 Joanie has not yet begun to menstruate and does not have any secondary sex characteristics. Her mother did note that Joanie has always been a very athletic child, had very little body fat and has always preferred more male activities. After taking these histories, consults in psychiatry, neurology and endocrinology have been called in and they found………………. In this case you need to diagnose both Richie and Joanie and also speculate as to why Richie’s science experiment was not working. Meanwhile in the E.R. the following cases were presented. An ambulance brought Mr. S. to the emergency room due to a rampage at the local post office. He was waiting in line, got up to the window and asked for a roll of stamps. Suddenly he began to accuse the postal worker of poisoning the stamps with LSD and he demanded that the roll be replaced. Even thought the postal worker made the switch, Mr. S began to destroy the place. He broke several windows, began shouting at the other customers that he would inform President Obama that these things were going on. When the police arrived on the scene, Mr. S was pacing up and down and kept looking behind him. He appeared to have poor personal hygiene and had no idea where he lived. While this was going on, the postal worker, Mr. K, started to complain that Mr. S was stealing his thoughts and he threatened to kill Mr. S with a secret laser gun he kept under the counter. The EMT’s decided to transport him as well to the E.R. Once they arrived at the hospital Mr. S was immediately sedated and moved far away from Mr. K., but then Mr. K began to have chest pains, inability to breath. He suddenly died. After a long search, the staff was able to locate Mr. S’s mother, who came to the hospital to see her son. When questions, Mrs. S seemed very slow in her speech and mannerisms. Mrs. S said that her son had done a tour of duty in the first Gulf War and was never the same when he returned. He had had a very bad addiction to heroin and other drugs, but was currently clean and sober. Mrs. S did remark that he seemed to be very forgetful of late and would become enraged at the smallest problem. He did complain of headaches in the front of his head, but they would come and go. She did say that her son had held her hostage recently in their basement for a period of three days, but he had meant no harm and was protecting her from “the people.” She was very pessimistic about her son’s life and the eventual outcome from this episode. When questioned about her own mental health, she got very agitated and left the hospital. The following week she retuned and was very upbeat, commented that she had not slept for three days and thought the world had gotten much better. She had on brand new clothes and had a new wardrobe of clothes for her son consisting of mostly Armani. We were puzzled by her purchase since she told us she worked only part time at a convenience store. You must diagnose, Mr. S, Mrs. S and Mr. K. 3 pages diagnose all patients.

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Due By (Pacific Time) 05/02/2015 12:00 am
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